FTW02LA006

NTSB accident investigation · Aerospatiale AS355F1 · Rosebud, TX · October 8, 2001

Accident · Minor injuriesLimited investigationFinal report
Date
October 7, 2001, 22:50 local (Oct 8, 2001, 03:50 UTC)
Place
Rosebud, TX
Injuries
2 minor, 1 uninjured
Damage
Substantial damage
Phase of flight
Enroute
Aircraft
N911BBAerospatiale AS355F1
Weather
Visual (VMC) · Night/dark
Status
Completed · report May 30, 2003
Report
Approved by Office Director
Parties
FAA FSDO, Rolls-Royce
FAA report
20011007032419A
Case key
53577

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

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Probable cause

The pilots impairment due to drugs. Contributing factors were the dark night light conditions, the pilot's failure to refuel, resulting in the total loss of engine power due to fuel exhaustion, and the pilot's misjudged landing flare.

Sequence of events

NTSB’s coding before 2008: each occurrence and phase of flight, and the causes and factors under it. The codes are defined in NTSB’s coding manual.

Loss of engine power(total) - nonmechanicalCruise
2 engines
Fluid,fuel - exhaustionFactor
Refueling - not performedPilot in commandFactor
Forced landingDescent - emergency
Autorotation - initiatedPilot in command
Hard landingLanding - flare/touchdown
Flare - misjudgedPilot in commandFactor
Impairment(drugs)Pilot in commandCause
Light condition - dark nightFactor
Roll overLanding - roll

Analysis

While en route on a positioning flight in dark night visual meteorological conditions, the Emergency Medical Service twin-engine helicopter was diverted to pick up a patient who was involved in an automobile accident. Upon arriving in the vicinity of the accident, the pilot had trouble locating the accident site. After circling the area several times, the pilot was informed that the patient was transported by ground vehicle. The flight departed the area for the initial intended destination. The pilot filed a company flight plan with an estimated time of arrival of 30 minutes and 40 minutes of fuel on board. About 10 minutes from destination, both of the helicopter's engines lost power, and the pilot initiated an autorotation. The pilot spotted what he believed to be a tree or bush and "flared a little high to miss the obstacle which caused a decrease in rotor rpm." During the landing, the helicopter touched down "hard," slid approximately 30-40 feet, before coming to rest on its left side following the separation of both landing skid tubes. Examination of the helicopter revealed that the fuel system was not compromised. During the examination of the fuel system, a total of 2 ounces of fuel was drained from both fuel filters and the fuel lines, which lead to the fuel nozzles. A total of 2 quarts of fuel was drained from both fuel tanks. Toxicology testing of the pilot was positive for methamphetamine (>20000 ng/ml) and amphetamine (2642 ng/ml). The operator reported that "the pilot admitted to taking medicine prescribed for his wife, and was taking this medicine for 3 days prior to the accident."

Factual narrative

On October 7, 2001, approximately 2250 central daylight time, an Aerospatiale AS355F1 twin-engine helicopter, N911BB, was substantially damaged during a hard landing following a total loss of engine power near Rosebud, Texas. The helicopter was registered to and operated by Southwest Helicopters, Inc. of Tucson, Arizona. The commercial pilot and one medical crewmember sustained minor injuries and the other medical crewmember was not injured. Dark night visual meteorological conditions prevailed, and a company visual flight rules (VFR) flight plan was filed for the 14 Code of Federal Regulations Part 91 positioning flight. The flight originated from Valley Mills, Texas, approximately 2130, and was destined for the Scott and White Memorial Hospital, Temple, Texas.

The pilot reported in his completed Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1/2, that about 10 to 15 minutes after departing Valley Mills, he received from Meds-com (dispatch and flight following) a mission about 65 miles to the east. Upon arrival at the destination, the mission was cancelled. The pilot further reported that the flight circled the area for about 10 minutes trying to locate the State Trooper; however, they could not find him. The flight then departed the area for the Scott and White Memorial Hospital. "About 10 to 15 min[utes] out from Scott and White with 13 to 14 percent of fuel left, the engines failed." He entered an autorotation and transmitted a mayday call. He maneuvered the helicopter to avoid a farmer's house and went in between two trees, decelerated over bales of hay, and pulled initial collective. The helicopter "hit hard and level" and slid approximately 30-40 feet before coming to rest on its left side. The pilot also reported that he "got into height perception illusion" and "pulled initial to high."

The operator reported in their completed Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1/2, that the helicopter, call sign Medivac 1, departed Valley Mills at 2130 for the return flight to the Scott and White Hospital. The pilot's company flight plan indicated 1 hour and 30 minutes of fuel on board with an en route time of 22 minutes. Approximately 2 minutes after departure, Medivac 1 was diverted to an accident scene in Leon County (31 degrees 10 minutes North and 96 degrees 7 minutes West). The pilot programmed in the lat/long, and advised Meds-com of an en route time of 39 minutes. At 2146, the pilot made a position report (31 degrees 19 minutes North and 96 degrees 50 minutes West). "Shortly after the position report," Meds-com contacted Medivac 1 with updated coordinates (31 degrees 9 minutes North and 96 degrees 7 minutes West) for the accident scene. After entering the new coordinates, the pilot adjusted his ETA to 25 minutes. The pilot called landing at the scene at 2225 (after 55 minutes of flight). Meds-com advised the pilot that the ground unit had departed the scene with the patient and requested that Medivac 1 meet them at a new location to pick up the patient. At 2240, after the mission was cancelled, Medivac 1 called in a position report (31 degrees 14 minutes North and 96 degrees 19 minutes West) and filed a flight plan to return to Scott and White Hospital with an ETA of 30 minutes and 40 minutes of fuel on board. At 2255, the pilot made a call to Meds-com stating he was making an emergency landing. The next contact Meds-com had with Medivac 1 was a telephone call from the flight nurse. The pilot reported to the operator that the engines flamed out and he entered autorotation to a field. He spotted what he believed to be a tree or bush and "flared a little high to miss the obstacle which caused a decrease in rotor rpm." The operator further reported that the pilot tested positive for amphetamines after the accident. The "pilot also admitted to taking medicine prescribed for his wife, and was taking this medicine for 3 days prior to the accident."

Toxicology testing of the pilot was completed at the Scott & White Hospital on October 8, 2001, at 0131. Toxicology tests were positive for methamphetamine (>20000 ng/ml) and amphetamine (2642 ng/ml).

Examination of the helicopter, by the Roll-Royce representative and FAA inspector who responded to the accident site, revealed that the tail boom was separated from the fuselage, both skid tubes were separated from the cross tubes, and all main rotor blades were damaged. Further examination of the helicopter revealed that the fuel system was not compromised. During the examination of the fuel system, a total of 2 ounces of fuel was drained from both fuel filters and the fuel lines, which lead to the fuel nozzles. A total of 2 quarts of fuel was drained from both fuel tanks.

Aircraft

Registration
N911BB
Reported as
Aerospatiale AS355F1
Category
Helicopter
Serial number
5099
Airframe hours
5,576.6
Engines
Allison 250-C20F, 420 horsepower, turbo shaftAllison 250-C20F, 420 horsepower, turbo shaft
Damage
Substantial damage
Flight
Positioning · Part 91
Registered owner
Southwest Helicopters, Inc.
Airworthiness certificate
Standard, Normal
Departed
9F1 · Valley Mills, TX
Destination
59XS · Temple, TX
Flight plan
VFR

Matched to the registry by N-number and the event date; the registry’s history has gaps, so older matches can be wrong. Compare the reported make and model.

Flight crew · 3

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
43
Injuries
Minor
Certificate
Commercial
Instrument ratings
Helicopter
Medical
Class 2, Valid Medical--w/ waivers/lim
Last flight review
May 2, 2001
Seat
Right
Toxicology
Performed
Flight hours
4,118 total · 86 in this make and model · 4,032 as pilot in command · 49 in the last 90 days · 16 in the last 30 days · 2 in the last 24 hours
Role
Other flight crew
Injuries
Minor
Role
Other flight crew
Injuries
None

Weather

Conditions
Visual (VMC) · Night/dark
Wind
225° at 5 knots
Visibility
10 statute miles
Lowest ceiling
None
Temperature
61 °F

FAA reports on this event · 1

The FAA’s own accident and incident reports, matched to the aircraft by N-number and date.